Virtual Mentor

Virtual Mentor. January 2003, Volume 5, Number 1.

Test Questions

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Test Questions: End-of-Life Care: Do No Harm

Multiple choice questions may have one or more than one right answer.

1. Which of the following is a primary goal of prognostication in cases of terminal illness?

a. Including patients in treatment planning.
b. Offering patients hope that they can beat the odds for survival of their illness.
c. Building a reputation for accurate prognosis.

2. Which of the following describe necessary characteristics of prognosis communication?

a. Direct and brief.
b. Realistic and sensitive to patient's desire for information.
c. Precise and scientific.

3. Which of the following in not permitted by the ethical standards of the medical profession as expressed in the AMA's Code of Medical Ethics?

a. Removing from the ventilator an unconscious patient with no respiratory capability who, while conscious, expressed a desire not to be ventilator-dependent.
b. Providing the necessary means or information to enable a patient to end his or her life.
c. Using dialysis as part of a comprehensive palliative treatment plan.

4. The physician-author of Clinical Case 2 (Ventilator Withdrawal of Patients with "Zero Capability" for Respiratory Function) believes that reactive opioid dosing during terminal ventilator withdrawal of patients who have zero respiratory capability but central respiratory drive in tact compromises patient comfort to the point where the principles of beneficence and non-maleficence are threatened.

a. True
b. False

5. Two patients are being withdrawn from the ventilator. While conscious, both expressed the wish to be disconnected from the ventilator when they could no longer stay alive without it. Both are expected to die as a result of ventilator withdrawal. Both have central respiratory drive in tact. Patient P has zero respiratory capability; patient Q has some respiratory capability. The author of Clinical Case 2 argues that:

a. Both patients P and Q should be given preemptive and definitive opioid and benzodiazepine doses to preclude the possibility of air hunger.
b. Patient P alone should receive the preemptive and definitive dose; giving the preemptive and definitive dose to patient Q might hasten his death.
c. Neither patient P or Q should receive the preemptive and definitive dose because doing so might hasten death.
d. Only patient Q should receive the preemptive and definitive dose because patient P cannot experience air hunger.

6. Which of the following accurately describes what occurs when the parents of a pediatric patient disagree with physicians about whether to treat the child's underlying disease?

a. Parents' interpretation of the patient's best interests always overrides medical judgment.
b. Medical judgment always overrides parental interpretation of patient's best interests.
c. Physicians may seek an ethics consultation.
d. Physicians may request a court-appointed guardian for the patient.

7. It is ethically acceptable for a physician who is formulating end-of-life treatment plans to consider which of the following?

  1. The patient's religious beliefs.
  2. The patient's wish to refuse life-extending treatment.
  3. The physician's discomfort with dying patients.
  4. What the physician thinks is in the patient's best interest.

8. Which of the following may result from failure to communicate realistic prognoses to patients?

a. Greater sense of patient autonomy and control.
b. Loss of trust between patient and physician.
c. Futile treatment.
d. Unfounded patient confidence that the physician can cure him or her.

9. In which of the following circumstances is it not acceptable to postpone or prolong communicating a terminal prognosis?

a. If the patient asks to wait until after his son's wedding week after next.
b. Because the physician thinks it will take this particular patient more time to accept the news.
c. Because the physician is not comfortable communicating the prognosis.
d. Because the patient asks to return with a family member.

10. Mr. K has been taking methadone, 60 mg by mouth every 6 hours, to control pain from metastatic cancer. He is now admitted with radiation-induced esophagitis, and your attending ask that you place him on a constant infusion of intravenous morphine. Without adjusting for cross tolerance, what hourly rate will you choose to control Mr. K's pain?

a. 1 mg/h
b. 2 mg/h
c. 5 mg/h
d. 8 mg/h

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